A CARE pathway in medication–overuse headache: the experience of the Headache Centre in Pavia

Abstract

Medication-overuse headache (MOH) [1] is one of the headache forms that most frequently prompts patients to consult a specialist headache centre. Literature data indicate an approximately 1%-2% prevalence of MOH in the general population [2][3][4]. Around 40% of patients seen at headache centres present with a chronic form of headache and 80% of these chronic headache patients make excessive use of symptomatic drugs [4]. A 2003 study by Dowson on the profile of patients seen at UK headache centres revealed that 60% suffer from a chronic form of headache and that 66% of these chronic headache sufferers regularly use analgesics [5].The literature contains few long-term observational studies investigating the risk of relapse into overuse. J Headache Pain (2005) 6:307-309 DOI 10.1007 A CARE pathway in medication-overuse headache: the experience of the Headache Centre in Pavia Grazia Sances Natascia Ghiotto Marianna Loi Elena Guaschino Enrico Marchioni Teresa Catarci Giuseppe NappiAbstract Medication-overuse headache (MOH) is one of the headache forms that most frequently prompts patients to consult a specialist headache centre. The prevalence of this form in the general population is approximately 1%-2%. Around 40% of patients seen at headache centres present with a chronic form of headache and 80% of this chronic headache patients make excessive use of symptomatic drugs. MOH shows a clinical improvement, accompained by a reduction in the consumption of analgesic drugs, if patients are submitted to detoxification therapy. But detoxification is only the first stage in a long and complex course of care and global approach demands adequate follow-up visit to prevent early relapses. At the Headache Centre of the C. Mondino Institute of Neurology in Pavia, a course of care (CARE) has been developed for the complente management of patients with MOH both during Hospitalization and durimg the subsequent follow-up period. CARE IS designed to trace the clinical, psychopathological and pharmacological profile of MOH in the short-, medium-and long-term; to look for factors possibility predictive of relapse; to assess the direct costs linked to overuse-headache in the year leading up to and following detoxification; and to evaluate disability, in terms of working days lost, before and after detoxification.

Short-term effectiveness of simple advice as a withdrawal strategy in simple and complicated medication overuse headache

“…As in our previous study [13] 11% of the MOH patients failed to adhere to the follow-up program, in most cases because they were dissatisfied with a treatment approach based solely on advice to withdraw symptomatic drugs. This is a relatively high drop-out rate compared with other studies [15]. In the 2006 study, we showed that the rate of adherence to treatment is independent of the detoxification strategy proposed.…”

Treatment of medication-overuse headache: A systematic review

“…We found 27 studies (45 articles) reporting the treatment response to early discontinuation therapy (9,12,14,24,25,. Among them, 19 studies (37 articles) reported the results of Early discontinuation with preventive medication (9,12,24,25,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64)(65)(66)(67)(68)(69).…”

Medication Overuse Headache and Applicability of the ICHD-II Diagnostic Criteria: 1-Year Follow-Up Study (CARE I Protocol)

“…We evaluated, in a prospective, non-randomized way, consecutive patients seen for the first time at the centre between May 2004 and January 2006 and who fulfilled revised ICHD-II criteria (7) for probable MOH (p-MOH). After giving their verbal informed consent to participate, patients were enrolled in the CARE I protocol (21). This consisted of a 2-month observational period during which the patients, awaiting hospitalization, monitored characteristics of headache and drug intake by means of an ad hoc diary (22).…”